September 15, 2023
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Donated lungs were the likely source of two cases of Legionnaires’ disease reported in transplant recipients at a Philadelphia hospital, investigators said.
It was the first time transplanted organs were identified as the likely source of a Legionella infection, the CDC said.
Data derived from McGinnis S, et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mmwr.mm7237a1.
The two patients received a single lung each from a donor who had drowned in a freshwater river, according to findings reported this week by investigators from the CDC, Temple University Hospital and state and city health departments. The Pennsylvania Department of Health was notified about the cases in July 2022.
Legionella, the cause of Legionnaires’ disease, occurs naturally in fresh water. Humans can be infected only by breathing in contaminated water droplets or aspirating contaminated water, not by drinking it.
Outbreaks are usually associated with water systems in large buildings, like hotels and hospitals. Exposure outside of these systems “is not generally considered a risk factor,” although infections attributed to aspiration during near-drowning incidents have been reported, the investigators wrote in MMWR.
Legionella was first identified in 1976 following an outbreak of pneumonia-like illness during an American Legion convention at a Philadelphia hotel, which is where the disease gets its name.
Although laboratory testing could not confirm that the donated lungs were the source of the infections reported last year, an investigation turned up no other Legionella infections at the hospital in the 6 months before or after the transplants, suggesting that the hospital water system was not the source.
“Clinicians should consider possible Legionella infection in organ transplant recipients who received an organ from a donor who drowned in fresh water,” the CDC said in an email to reporters. “Prompt identification of Legionella infection can help with rapid treatment and prevent further complications or death. Post-transplant antimicrobials could be tailored to include agents that combat atypical waterborne organisms.”
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